Provider Demographics
NPI:1780681163
Name:ROBISON, GEORGE RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RANDOLPH
Last Name:ROBISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PAYTON GIN RD
Mailing Address - Street 2:STE S
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6766
Mailing Address - Country:US
Mailing Address - Phone:512-837-2937
Mailing Address - Fax:512-837-7181
Practice Address - Street 1:1000 PAYTON GIN RD
Practice Address - Street 2:STE S
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6766
Practice Address - Country:US
Practice Address - Phone:512-837-2937
Practice Address - Fax:512-837-7181
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6586207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081414701Medicaid
0094BHMedicare ID - Type Unspecified
TX081414701Medicaid